Stage 2 NLA
· ·

Stage 2 NLA

Image by Freepik

Last time we asked: is our child ready tp move to Stage 2 NLA (Natural Language Acquisition stage 2) and we looked at how we can know. Now we know: he/she is ready, they are mixing and matching those scripts quite liberally! Hurrah!

So for example we hear phrases like:

  • ‘let’s go’+ ‘downstairs’
  • ‘it’s’ + ‘downstairs’
  • ‘I see it’ + ‘downstairs‘
  • ‘I want to’ + ‘shoes downstairs’ (I want to put my shoes on downstairs)

To recap, it’s important to listen out to a variety of contexts because if we only hear the single version of a gestalt —this is so great, hurrah!— but that’s not yet Stage 2.

What we can now do on a daily basis to help and support at this time:

1. We need to offer more ‘mix and match’ phrases to help our child establish this new way of communicating.

Good phrases:

  • It’s … raining / cooking / eating / washing / brushing
  • That’s … great / cool / amazing / wow / so good
  • Let’s … see / look / go / run / chase
  • How’bout … some food / playing / I’ll chase / sleeping / we read a book
  • I see a … bird / large car / fire engine
  • I wanna … have a biscuit / have a book / have a snuggle
  • We’re … going out / going home / going in the car / going upstairs

Here in my video clip of train play I use:

  • Let’s go
  • It’s going up the hill
  • It’s coming down
  • Ooops it falls!
  • It’s stopping
  • Let’s put on another parcel
  • Ready steady go
  • Off we go
  • It’s come off!
  • Let’s fix it
  • I can do it
  • I don’t need help

You can offer these gestalts either with an AAC as you can see me do in the video clip or you can just verbally offer these.

2. Watch out for Pronoun confusion or reversal:

Gestalt kids repeat gestalts, so we don’t want to create ‘pronoun reversal’.

Instead model from a:

  • first person perspective: ‘I’ / ‘Our’ / ‘Us’
  • joint perspective: ‘We’ / ‘Let’s’ or a
  • neutral perspective: ‘It’

You can turn almost any sentence into a good language model once you get used to it. And you can avoid ‘you’ and ‘your’ at the same time!

So instead of saying, ‘Do you want to go to the park?’

You could say:

  • We wanna go to the park?
  • Let’s go out?
  • Shall we go out / to the park?

3. Start providing ‘variation’ in your language modelling:

Instead of just modelling something one way, start thinking about offering a pattern in a couple of other ways, in a couple of different situations, then several ways in several different situations.

Example: once you hear your child saying: ‘it’s raining’ and you know it’s a mitigation, because you don’t often say ‘it’s raining’, or haven’t said it in a while and you know your child says other ‘it’s’ phrases.

Repeat: ‘it’s raining!’

Then: ‘it’s’ + ‘raining hard’ / ‘it’s wet out there’ / ‘It’s’ + ‘raining lot’s’.

Then later think of other combinations for ‘it’s’ + ‘something’:

  • (rice) ‘It’s’ + ‘cooking’
  • (water/tap) ‘It’s’ + ‘running’
  • (radio) ‘It’s’ + ‘singing
  • (dog) ‘It’s’ + ‘peeing’ / ‘it’s’ + ‘running’ / ‘it’s’ + ‘jumping’

In my train video clip:

  • Let’s go
  • It’s going
  • Let’s make it go
  • Ready steady go
  • Oops its gone

4. Use natural intonation that shows you really mean what you’re saying.

You can be animated or try for musical if your child prefers that / doesn’t mind you singing —they might not like it if their hearing is pitch perfect and your singing is off key…—

  • ‘I’m’ + ‘trying to find you!’ (animated, goofy face)
  • ‘I’m’ +’ getting tired!’ (exaggerated stretch and yawn)
  • ‘I’m’ + ‘catching up with you!’ (animated goofy)
  • ‘I’m’ + ‘gonna get you!’ (animated goofy)
  • ‘I’m’ + ‘sad right now’ (exaggerated face and tone of voice)

5. USE SILENCE!

Important, I might not have said this before but we need to hold back sometimes (hard I know) and not constantly offer models. Let our child sit in a bit of silence with us there just observing and waiting for their own offers. This is a very important point. Silence is golden sometimes. Try it out. I am not talking about the silence that comes with a person scrolling on their phone though, we do need to be present and receptive.

You will see this works wonders!

Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.

You can also check my friend’s lovely handmade jewelry on her website.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

1
How do we know our Gestalt Learner is moving to Stage 2?
· ·

How do we know our Gestalt Learner is moving to Stage 2?

Image by Freepik

Is our student ready to move to NLA 2 (Natural Language Acquisition stage 2)?

We know that the GLP (Gestalt Language Processor) will move into the next stage when they are ready. But are they now ready you might think? When are they ready? How do I know? If you are not sure whether your child is ready to move forward then go and see your GLP trained Speech Therapist. Together you can work out what the next steps are and how to help your child settle into NLA 2. It’s very exciting!!

Tip

The first useful tip: keep a language sample of phrases your child says. This is very helpful!

You might want to check with your Speech Therapist and offer some language sampling you have taken so they can help you figure out where your child is currently. Always keep an Utterance Journal that you can share with your Speech Therapist and with others who look after your child.

Basically, we want to listen out for phrases our child says that you or nursery don’t say routinely; that way you can presume that this is not an echo but a mixing together of two chunks of gestalts. Watch out for those coco melon phrases though: double check it really isn’t an NLA 1 gestalt that is copied verbatim from a favourite you tube video.

You can best support your child best by listening, and thus figuring out what your child is TRYING TO SAY. Often your child might skip over the parts of gestalts they don’t want to say. This is common in older kids who have long gestalts, sometimes even whole episodes or whole stories!

Try and tease out their shorter mitigations and then focus on practicing and modelling those as they are so much more useful!

So back to our question: are they ready?

Are their gestalts covering a variety of situations and contexts?

Make a note in your journal to see what the backgrounds are to each phrase you ear, so for example:

  • Transitioning: ‘it’s time for the park’ ‘what’s next’ ‘shoes on’
  • Bed Time: ‘we need to wash’ ‘let’s get in (bath/bed)’ ‘ready for our book’
  • Toilet/nappy: ‘we need the potty’ ‘where’s the potty’ ‘let’s wash hands’
  • Mealtime: ‘time to eat’ ‘go get a spoon’ ‘yummy num num’
  • Park/going out: ‘look at the squirrel’ ‘funny doggy’ ‘I wanna swing’
  • At the shops: ‘let’s get the trolley’ ‘lots of veggies’ ‘no tomatoes’ ‘ooh long queue’ ‘back to the car’

And… does the child use the phrases for a variety of functions?

  • labelling
  • providing information
  • calling out
  • affirming
  • requesting
  • protesting
  • directing

We need to offer lots of similar language models so that in their own time our children can extract/mitigate useful phrases for what they want to express. The more similar utterances a child hears around him the more he/she can discover the communalities. Once the child has a small range of phrases, he/she can mix them up and create semi-original own phrases.

If the answer is YES!! our child has perhaps not all but a range of functions and a range of situations where they use a variety of easily mitigable gestalts then yes they are ready for moving to stage 2 of NLA!

Hurrah!

Keeping a journal of what your child is saying and in what circumstance is crucial to help with our ongoing detective work!

Next time I will be looking at how we can help our NLA 2 GLP produce even more of their own mix and match phrases.

If you need help with your child, please do not hesitate to contact me.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

1
A day in my life as an Independent Speech and Language Therapist

A day in my life as an Independent Speech and Language Therapist

During the pandemic I wrote a blog on what my working day looked like. Now a good year has passed since coming back to some sort of normality and I thought I would update this ‘day in the life of an SLT’ as my working life has changed of course to reflect the ‘new normal’.

I have become truly busy, perhaps busier than I have ever been to be honest. It’s probably mostly due to the fact that I do most of the aspects of my work myself — though I want to mention two invaluable people here without whom I could not function as well as I do: the excellent Nathalie Mahieu () helps me with my SEO, Insta posts and blog uploading and the wonderful Sue Bainbridge () makes sure that my accounts don’t get into trouble with His Majesty’s tax office.

Attached to our role as Speech and Language Therapists is an arguably enormous amount of administration/paperwork and preparation required for each and every client. This needs to be factored in when deciding how many families I can realistically see each working day. For me it works out as typically 3–5 clients a day, Monday to Friday.

So how does my day typically look? Each day varies a lot depending on what type of client I have, but on average it looks a bit like this:

First thing in the morning — after having a coffee and a quick check-in with my besties on WhatsApp — I do my Buddhist chanting for about an hour. My Buddhist prayers are the base of all I do and get me connected to my higher purpose and how to create value with each activity and each person I see that day. It sets me up for the day, I keep in mind who is going to come and see me and how I can best help them.

Next up, I do the daily ‘spring-clean’ of my therapy room (on all fours! no joke ???? those kids see every speck!), vacuum the floors, wipe down the toys with flash-wipes and tidy up all my boxes, making sure that the battery toys are working, and everything else is in place. On to the guest toilet, the hallway needs to be rid of all the men’s shoes and trainers and coats… It’s endless what needs tidying when you are living with three men… This takes about 45 minutes.

An articulation activity – packaging practice into a little game

Then I prep for all my clients that day. I have now got so much quicker about selecting therapy materials. For one thing I have purchased so many toys and materials over the past five years that I can literally now open a shop and need to consider building an extension! ???? The upside is that it is now very easy for me to select a good handful of toys or games for any one child, even at a minute’s notice. Though, on average, I spend about 30 minutes per child preparing activities.

Hurrah, it’s 11 am and my first client of the day arrives and the fun begins.

When they leave around an hour later, the cleaning and wiping down starts again, this time less extensively. I write up my notes and send homework whilst enjoying a cuppa.

The next client comes at 12.30 pm and once they have left, floor cleaned, toys wiped, notes written it is time for a quick lunch. No more than half an hour usually.

Afternoon clients tend to be one more little one (nursery age) at 2.15 pm and thereafter I see mostly older school children for a variety of reasons (mainly speech production but also some language-based activities). I tend to say farewell to my last client of the day around 6 pm. I spend another hour, sometimes more, on writing up notes, answering new enquiries, blogging and phone calls to keep my service fresh, inspirational and exciting.

And then dinner and the rest of the day rushes by. I tend to finish my day with some more Buddhist chanting, not a lot, perhaps 10–20 minutes to reflect on what has gone well and what could have been better — re-determine to improve or make better as needed.

Tele therapy activity using online materials plus a coreboard

In terms of where I provide a service, I still do a good mix of online clients (tele-therapy) and in-person clients in my clinic, which I love. Occasionally, I visit children in their nursery or at home but this service is now only available for long-standing clients.

Each client is hand-picked to make sure that we are a good fit: no one client gets the same treatment as another; each client is unique, we get to know one another well over the time we work together and they are always highly valued. That takes time and, in reality, each client gets about two hours of my time. That is the actual session plus all the preparation and aftercare, i.e., bespoke hand holding, tweaks, problem solving and reassurance in between sessions.

I absolutely love this way of working and would not ever want to do anything else. Nearly three decades of working both in the NHS and in private practice, countless courses (continual professional development) have enabled me to flourish as a therapist and I know that I offer something special and very valuable to my clients.

My unique way of working affords all my lovely clients the help they need to support their children to make progress; and it gives me the right balance of job satisfaction and work life balance for now. My lovely reviews and testimonials tell me that my clients appreciate my service and this at the end of the day is the most important.

If you are interested in exploring Buddhism/buddhist chanting then check out this link (https://sgi-uk.org/), and feel free to contact me about that specifically, regardless of whether you want speech therapy. I am always happy to chat about Buddhism, it has been so enriching for the last 43 years of my life.

If you need help with your child, please do not hesitate to contact me.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

1
Autism – Benefits of Early Assessment and Intervention
· · ·

Autism – Benefits of Early Assessment and Intervention

I think my child might be autistic – how can we help?
Image by macrovector on Freepik

Consulting a Specialist Speech and Language Therapist can help you in several ways: assessment, informal and formal observation, discussion and advice, onward referrals, direct intervention, parent coaching, educational support and much more, all geared towards supporting you the parents, and helping your child to flourish and thrive.

First up, we can help you with assessment and advice: with a wealth of expertise in observing childrens’ play and communication, as well as knowledge of the latest research we can see a child’s strengths and areas of struggle very quickly indeed.

Within a short space of time, we can identify the areas we need to focus on and start guiding you towards helping your child to connect, respond, react and feel better.

Early detection is key

If autism is detected in infancy, then therapy can take full advantage of the brain’s plasticity. It is hard to diagnose Autism before 18 months but there are early signs we know to look out for. Let’s have a brief look at the sorts of things we look at.

The earliest signs of Autism involve more of an absence of typical behaviours and not the presence of atypical ones.

  • Often the earliest signs are that a baby is very quiet and undemanding. Some babies don’t respond to being cuddled or spoken to. Baby is being described as a ‘good baby, so quiet, no trouble at all’.
  • Baby is very object focused: he/she may look for long periods of time at a red spot/twinkly item further away, at the corner of the room for example.
  • Baby does not make eye contact: we can often see that a baby looks at your glasses for example instead of ‘connecting’ with your eyes.
  • At around 4 months we should see a baby copying adults’ facial expressions and some body movements, gestures and then increasingly cooing sounds we make; babies who were later diagnosed with autism were not seen to be doing this.
  • Baby does not respond with smiles by about 6 months.
  • By about 9 months, baby does not share sounds in a back-and-forth fashion.
  • By about 12 months baby does not respond/turn their heads when their name is called.
  • By around 16 months we have no spoken words; perhaps we hear sounds that sound like ‘speech’ but we cannot make out what the sounds are.
  • By about 24 months we see no meaningful two-word combinations that are self-generated by the toddler. We might see some copying of single words.

24 months plus:

  • Our child is not interested in other children or people and seems unaware of others in the same room/play area.
  • Our child prefers to play alone, and dislikes being touched, held or cuddled.
  • He/she does not share an interest or draw attention to their own achievements e.g., ‘daddy look I got a dog’.
  • We can see our child not being aware that others are talking to them.
  • We see very little creative pretend play.
  • In the nursery our child might be rough with other children, pushing, pinching or scratching, biting sometimes; or our child might simply not interact with others and be unable to sit in a circle when asked to.

What sort of speech and language difficulties might we see?

Our child might do any of the following:

  • have no speech at all, but uses body movements to request things, takes adults by the hand
  • repeat the same word or phrase over and over; sometimes straight away after we have said it or sometimes hours later
  • repeat phrases and songs from adverts or videos, nursery rhymes or what dad says every day when he gets back from work etc.
  • copy our way of intonation
  • not understand questions – and respond by repeating the question just asked:
    • adult: Do you want apple? child: do you want apple?
  • not understand directions or only high frequency directions in daily life
  • avoid eye contact or sometimes ‘stares’
  • lack of pointing or other gestures

Common behaviours:

  • Hand flapping
  • Rocking back-and-forth
  • Finger flicking or wriggling/moving
  • Lining up items/toys
  • Wheel spinning, spinning around self
  • Flicking lights on and off, or other switches
  • Running back-and-forth in the room, needing to touch each wall/door
  • Loud screaming when excited
  • Bashing ears when frustrated or excited
  • Atypical postures or walking, tip toeing, can be falling over easily, uncoordinated
  • Can be hyper sensitive to noises, smells, textures, foods, clothing, hair cutting, washing etc.
  • Being rigid and inflexible, needing to stick to routines, unable to transition into new environments
  • Food sensitivity, food avoidance, food phobias

I mentioned this to be a ‘brief’ look at the areas and it is: each topic is looked at very deeply and each area is multi-facetted therefore a diagnosis is rarely arrived at very quickly. We want to make sure we have covered all aspects and have got to know your child very well before coming to conclusions.

Early detection is key, because we want to start helping your child to make progress as quickly as is possible. If you feel /know that your child is delayed in their speech and language development and you would like a professional opinion then please do contact me, I look forward to supporting you. It is important to know at this point, that if your child only has one or two of the above aspects it may mean that your child is simply delayed for reasons other than Autism and if that is the case, we will be able to help you iron out a few areas of need so that your child can go on thriving.

If you need help with your child, please do not hesitate to contact me.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

1
How do we play with our Gestalt Language Processors?
· · ·

How do we play with our Gestalt Language Processors?

Image by Freepik

Child-led therapy

When working with Gestalt Language Processors, it is always advisable to use child-led therapy. What does that mean? Child led therapy involves following a child’s interests and allowing her/him to lead the play activity throughout the speech and language therapy session. In other words, instead of having my own ideas of what we might want to play with or what activities I might try and use, I provide a range of toys I know the child likes or has played well with before; then I wait for the child to pick what she/he enjoys doing.

Play can be very repetitive and we can often see our child cycling back to the same one or two toys throughout the session. But this is what she/he needs to do at that time and it means that we have focused attention and engagement. This in turn is very helpful for the therapeutic process, which is to offer great scripts and phrases/words alongside what she/he is playing with.

Monotropic minds

Often the mind of autistic children is more strongly pulled towards a smaller number of interests or hobbies as I like to call them. Dr Dinah Murray, Dr Winn Lawson and Mike Lesser have found in 2005 that autistic people have ‘monotropic’ minds. They explain that autistic children focus their energy on a narrow range of activities as the energy required to switch between several toys is much higher than we would see in the neuro-typical population.

Gestalt Language Processors are often also Gestalt Cognitive Processors. This is when experiences are retained as episodic events and memories. An event is remembered by specific parts of the same event. And, therefore, these specific parts should always be part of that event, when the event is repeated.

Should any of the specifics be changed or are missing, then this can cause great upset to Gestalt Cognitive Processors. So, for example, if the last two times in speech therapy we had the train set out and this was played with happily, then this becomes a specific part of the whole session. If, I then don’t offer the train set the third time a child comes to see me, this could be very upsetting.

This is why I tend to try this out and see what happens. Usually in the 3rd or 4th session: I might not bring out the car run that has hitherto been super successful to see if we are able to transition well to other toys. If yes, then we can have new experiences but if not then I will re-offer the car run/or whatever toy pretty quickly so as not to cause complete dysregulation.

A few pointers below which help with child-led play:

Introduce a few new toys and see what happens

Parents are encouraged to bring some familiar toys their child likes to the session. We can then introduce a couple of different toys to see how we go. Try offering a new toy alongside the familiar one; try offering new toys without the familiar one present, but be prepared to re-offer the “old” toy should our child get upset.

Rotate toys and don’t offer out too many toys

I find that children can get overwhelmed and overstimulated by too many items out all at once. I always talk to parents about toy rotation at home and I encourage storage and ‘tidy up’ of toys so that we can increase attention focus, and also maintain freshness and new interest in older toys.

Some children are not yet ready to play with toys

Here I suggest people games: these are games where the adult becomes part of a more motor-based activity. Some call it ‘rough and tumble play’ but it can be nursery rhymes such as sleeping bunnies/row row the boat or peek-a-boo for the younger ones.

Copy/Imitation is so important – try getting two identical or similar play items

When we are copying our child, it is often not desirable to ‘take turns’ with their toys/blogs/cars etc as our child may not be ready to let us take a turn. Instead, if we have the exact same toy that our child is having then we can play alongside our child and copy them perfectly without interrupting their play.

References:

Murray, D., Lesser, M., & Lawson, W. (2005). Attention, monotropism and the diagnostic criteria for autism. Autism9(2), 139-156.

If you need help with your child, please do not hesitate to contact me.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

0
Developing Joint Attention
· · ·

Developing Joint Attention

Image by Freepik

Joint attention skills what are they and how can we facilitate those?

Most of us want to make friends, connect with others and bond with a friend or be part of a community. To do so we need to develop an important social skill which is: initiating, responding to, and maintaining ‘shared/joint attention’ with another. When we can do this, we are able to focus on the same thing with another person or a group of people: music, hobbies, sport, art, books, toys, games or memories: remember when we did x y z…

Many children who struggle with speech and language development are not able to share or hold attention with another person very easily. My latest blog is all about what we can do to help our children develop Joint Attention.

So to re-cap, joint or shared attention happens when one person gets the other’s attention by either words, or gestures like pointing to something and saying ‘OMG look over there!’ – both people look at that same thing.

What does it take to have or develop this skill?

We need to first of all find something of interest that captivates our own attention. This part is usually not difficult for most people or children.

Then, crucially, we need to direct our focus away from what we find interesting, for long enough to get another person’s attention onto the same topic. This could be just seconds or it could be longer if we are very determined and good at embracing others into our experience. But if we are not then it must not take longer than seconds!

Let me give an example: if someone is in the room with me whilst I see something strange out the window, I would take that second to draw their attention to it. However, I might not be bothered to run upstairs and find someone only to show them something odd outside in the road. If I am very bored, I might do! But as I am rarely bored it is unlikely. So, unless someone else is right here with me, they are not going to be part of that particular experience, I would not share it.

Back to our child: if we make it difficult for a child who is not naturally inclined to share an interest then it is not going to happen. We must be ready, and right there for our child to have that fleeting second to look at us before returning to their hobby/interest.

This skill ‘to share a moment’ tends to develop around 12 months of age and starts with a child pointing to things. Prior to that, our child might give us something or come to show us a thing. Joint attention underpins language skills and is strong predictors of later language development (Law et al, 2017).

What are the signs that my child is struggling with Joint Attention?

  • Tunes out or does not respond when I call their name
  • Cannot follow my suggestions for games or toys/play activities
  • Does not point to anything of interest, like a truck passing by, or an aeroplane in the sky
  • Ignores or does not respond to what I say, does not follow instructions, only when he/she wants to

What can I do to help with this?

Here are some ideas you can follow in no particular order – see which one sticks:

  1. Get down to your child’s eye/face level, we call it ‘face to face’. It does not require your child to make eye contact with you but they might just do so more easily if you are ‘just there’ and don’t have to crook their neck to look up at you. When reading a book with your child, instead of sitting behind try sitting opposite him/her.
  2. Mirror play – making funny faces together in a mirror can be fun.
  3. COPY your child: top tip!! Imitate your child’s vocalisations and actions. Even if these are repetitive, just enjoy the ride.
  4. Follow your child and let your child take the lead in the play activity. What does that look like? The adult has no agenda, does not want to teach, to ask questions (see point number 9) does not want to direct or show the child how to ‘do it better/differently’ – instead accept that the child is the boss when it comes to their play and take their lead in how a toy should be played with.
  5. Hold up objects to your face or at eye level so that your child can see your face and the item at the same time.
  6. Be the ‘funniest thing’ in the room; be hugely entertaining, watchable and offer the ‘irresistible invitation’ to look at you or play with you.
  7. Offer PEOPLE TOYS (any toy where another person is needed to have fun) so: wind-up toys, bubbles, anything that needs opening or holding or doing which is tricky for the child to do alone. I always try and hide the buttons that make something ‘go’ so that my child needs to come back to me for ‘more/again’.
  8. Do PEOPLE GAMES – as above really but games that do not need a toy, that need another person to have fun: being swung round, row row the boat, being pushed on a swing etc.
  9. REDUCE ASKING QUESTIONS – this is my favourite top tip!!! Instead of asking lots of questions try and make simple statements/comments on what is happening so there is absolutely no pressure on your child to ‘perform’. Equally, silence is actually golden sometimes! An odd bit of advice from a speech therapist? Try sitting with your child, next to them or opposite and just don’t talk but simply BE… yes easier said than done, I do know this. Turn off your phone (OMG did I just say that!?) yes, please turn it off and just be with your child for a little while, just like a comfy buddy who is just enjoying their company with no agenda. You might be very surprised how your child suddenly seeks you out!

I will write about more ideas on this in my next blog so look out for more play ideas to encourage Joint Attention.

Most important, try and have fun with your child. Think about what is fun for her or him. And make it EASY for your child, remember unless you are ‘right there’ it might not happen so easily.

Happy New Year!

If you need help with your child, please do not hesitate to contact me.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

0
Rethinking the PECS Approach
·

Rethinking the PECS Approach

I want to talk about some concerns of SLTs, parents and increasingly autistic adults who explain to us how this communication method did not really work so well and why.

What is PECS in a nutshell:

PECS (Picture Exchange Communication System) is based on the idea of exchanging pictures in return for desired items. For more advanced users, it is used to communicate different functions such as emotions, comments, negations using the exchange of a sentence strip. It was founded on the principles of Applied Behavioural Analysis (ABA).

How does that look in practice?

In my experience, having been trained in the approach myself, the overall aim is eventually for the child to spontaneously go and get their picture book (PECS book), open it, look through a range of pages to select the correct picture of what they want to have or say, then go and find their communication partner, and finally place that picture onto the communication partner’s outstretched palm to be rewarded with an item or with a response of some sort. Or the child selects a range of pictures to create a little sentence, such as: ‘the blue fish swims in the sea’, ‘the red bird flies in the sky’ or ‘I see a red bird’ for example. This can be part of a structured table top activity.

The system follows a series of phases, starting from simple picture exchanges to eventually construction of sentences using symbols. PECS’s aim is to promote communication initiation and reduce frustration for those who struggle with speech.

So far so good one might say, why not? Before I go into the various concerns, I would want to add my own working experience with PECS, and whilst it is my opinion, I would say I have NEVER seen a working PECS book being used spontaneously!

My experience

I have seen attempts of stages 1 and 2 done quite well, in schools, and where people knew that I was coming in “to have a look at how PECS is working with child X”. Yes, in those instances an effort was made of course to try and show me how it worked. I must add that have never been very impressed. I cannot recall it used for any other items than: biscuits/quavers/crisps/ raisins and bubbles/puzzle pieces or spinners.

If we want to see a child trained to exchange for these items in a structured setting, i.e., the child sits at a little table with the adult sitting opposite enticing the child with one or other item, then yes that can be done successfully. I have seen children exchange 25 pictures with a crisp on it, for said crisp and they might have asked for another 25 of those crisps given half the chance. Yes. Good. But. I have yet to see a child go to their PECS book and go through all the motions that I mentioned above to get a crisp. In school they don’t need to: they know that crisps are only available when the PECS book is being practised. Otherwise, let’s be honest, it’s fruit at 10.30 am!

So, they don’t get a spontaneous opportunity to ask for highly motivating items as that is not how school works, is it? ‘SIR! Can I have a crisp?’ At 10.02am, in the middle of maths? Didn’t think so… So in reality this does not get practised in my experience.

A few concerns in no particular order:

Limited Generalisation

One issue often raised is the limited generalisation of skills learned through PECS. The structured nature of the program may result in a child only being able to communicate effectively within the specific contexts where they were taught to use the system (as I suggest above: crisps: yes, please let’s do the PECS for it). This limitation can pose challenges when trying to apply communication skills in new or unstructured/spontaneous situations.

Lack of Spontaneity

Critics suggest that PECS can sometimes lead to scripted and less spontaneous communication. This is also what I have observed. Since the method is designed to follow a structured progression, there is a concern that individuals might struggle to initiate communication outside of the established framework, potentially hindering their ability to engage in more natural interactions.

Narrow range of communication functions being practised

While PECS is quite successful in focusing on requesting and naming items, there are many other important communication functions, such as expressing emotions, asking questions, giving opinions or greetings for instance. We can argue that a communication core board where we have a whole range of different core words available lends itself much better to practising a range of communicative functions.

The Pictures are movable

They are attached to the book via Velcro. They are constantly being picked and exchanged and then returned to the book. This means that the pictures tend to be always in different places. This goes against the motor planning that takes place when one is learning a new skill: imagine you want to learn to touch type and the letters always move and are at different places? How can you be quick about finding a letter? You can never get to “automatic” with this type of approach.

Communication is not taught via behavioural means

Only if you say “banana” in the way that I dictate that you should will you get a piece of banana. Who does that? Nobody. Typically, child points to the counter where there is a banana and says: ‘ba’ or ‘ana’ and mother/carer will look over there and say ‘oh banana! You want a banana? Ok there you go have a piece.’ Or something like it. Mother will not say: ‘SAY BANANA or else you won’t get it.’ Child hears mum saying ‘Banana’ each time and with time will point and say ‘banana’ or ‘I want-a-nana’ or something. This is how communication is learned: through the adult modelling it cheerfully all day long and the child hearing it and then gradually copying it.

One other gripe I personally have but I am reliably informed by all my parents that they share this about PECS:

IT IS SO LABOUR INTENSIVE!

There are 10, 50, 100’s of little pictures that first of all need laminating… then velcroing, then finding and replacing. As I said above, it’s a constant moveable feast for one, but also you LOSE them. Yep. You want to find the picture for “trampoline”. ‘Where is it? I saw it yesterday… We had it outside when we practised you asking for the trampoline. I am sure we put it back? Where is it??? Ok. We need to print off a new one.’

It is also labour intensive for the first stage where you need to have TWO adults to ease the exchange (pick up and release of picture into the communication partner’s hand). Who has two adults available for what can be weeks until the child is able to pick up and release by themselves?

YEP. So it’s really not for me you can tell! I much prefer Core boards (see my previous post on using one) or electronic speech generating AAC devices like GRID, or LAMP or TOUCHCHAT. These are all great to use and there is good support out there for introducing these.

Finding a Balance

While the concerns surrounding the PECS approach are valid, it’s fair to note that the method also has some merits. There is anecdotal evidence of many individuals who have successfully improved their communication skills and quality of life through PECS. But, finding a balance between using PECS as a stepping stone and ensuring the development of more comprehensive and SPONTANEOUS communication is key.

As educators and therapists, we need to extend the focus beyond requesting and labelling by incorporating symbols that represent emotions, actions, and more complex ideas. This expansion encourages a broader range of communication functions. When the time is right, gradually transitioning from PECS to more advanced communication methods such as Core boards or electronic AAC tools and speech-generating devices is the way forward.

We want to value all communication equally and our approach ought to be playful and child-led and to focus on intrinsic motivation instead of extrinsic rewards and reinforcers.

If you have any questions or if you are looking for a therapist who endorses play-based and child-led therapy approaches, please do reach out.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

0
Empowering non-speaking children: the power of AAC Core Boards
·

Empowering non-speaking children: the power of AAC Core Boards

Communication is the essence of human interaction, allowing us to express thoughts, feelings, wants and needs. For non-speaking children and their families finding an avenue to communicate effectively can be a really challenging journey.

Augmentative and Alternative Communication (AAC) offers a solution: with AAC Core Boards as a powerful ally and tool to empower and express more than requests: ideas, comments, surprise and delight, as well as saying no to something! Very important!

“AAC is a set of tools and strategies that an individual uses to solve every day communicative challenges. Communication can take many forms such as: speech, a shared glance, text, gestures, facial expressions, touch, sign language, symbols, pictures, and speech-generating devices” (RCSLT, 2023) to name just some.

AAC Core Boards are a powerful tool to empower non-speakers to express ideas. In this blog, we’ll explore the significance of AAC Core Boards and how they can unlock the world of communication for non-speaking children.

Let’s discover and understand AAC Core Boards

Firstly, let’s look at what a Core Board looks like…

AAC Coreboards
Credit: Saltillo Word Power

Why not have a go and download your own copy (and other boards) for free on the Saltillo Word Power website.

AAC Core Boards are a specific type of AAC system that employs a grid-style board. This grid contains a set of core vocabulary words or symbols, which serve as a foundation for all communicative functions (e.g., initiating, greeting, requesting, negating, commenting, asking a question, and expressing surprise).

These boards incorporate high-frequency (most used) and versatile words. They enable us to construct sentences, express emotions, and take part in conversations, fostering a sense of independence and autonomy. By enabling communication, we also remove some of the frustration (from not being able to communicate) which contributes/or often leads to behavioural difficulties.

Building literacy skills

AAC Core Boards are not only tools for immediate communication. They also play a pivotal role in language and literacy development. By using these boards, non-verbal children engage with words and symbols. It reinforces their understanding of language structure and grammar.

As they consistently play with and then use their boards, they naturally absorb language patterns, laying the foundation for improved literacy skills. This immersive learning experience paves the way for future language acquisition and communication growth.

Customisation for individual needs

Every child is unique, and their communication needs can vary significantly. AAC Core Boards are designed with this diversity in mind, allowing for customisation to suit individual preferences and abilities. The boards can be adapted to include specific vocabulary relevant to a child’s daily life, interests, and activities. This personalisation ensures that the AAC Core Board is a true reflection of your child’s personality and needs, making communication more motivating, engaging and effective.

Collaboration between AAC Core Boards and Speech Therapy

AAC Core Boards are an excellent tool but we need to know one important aspect: they only work well when used regularly by the child’s family and key people in the first place.

The board needs to be used and modelled by adults consistently and regularly across environments. This is so our children know what to expect, take an interest and begin to use the boards themselves. Modelling the use of AAC Core boards is vital. Think how long it typically takes for a child to learn their first word. Around a year! During that time the adults talk constantly to their child without hesitation or expectation! The same goes for introducing this new way of communicating.

Collaborating with your child’s Speech and Language Therapist (SLT) ensures that your child receives the right guidance in using the AAC system. SLTs can assess your child’s communication abilities, recommend appropriate boards and provide guidance on how to best put them in place, so that your child can reach their communicative potential.

For non-speaking children, AAC Core Boards are more than just tools. They are bridges to a world of communication, connection, and empowerment. These boards harness the power of visual communication, foster language development, social interaction, and personal expression. They can be tailored to individual needs with the support of skilled professionals. AAC Core Boards offer a beacon of hope, helping to break through communication barriers and thrive in a world that is waiting to hear your child’s voice.

For answers to your questions and to explore the most effective support for your child, feel free to contact us.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

0